Bipolar Disorder

Bipolar disorder is a syndrome in which a person experiences unusual changes in mood, typically from “highs” that are full of energy and activity, to “lows” in which the person experiences depression and dark moods. This used to be called “manic-depression” because people see-sawed between manic (highly active) moods and depressive moods.  According to some statistics, as many as 5.7 million U.S. adults (about 2.5% of the adult population) suffer from bipolar disorder, and it affects both men and women as well as people from all races, economic levels, and ethnic backgrounds (WebMD, 2005-2011). This report offers a brief overview of bipolar disorder, its pathology, different treatment agents, necessary monitoring and follow-up, and the toxicities for medications used in its treatment, including a brief discussion of SSRIs and bipolar disorder.

Pathology of Bipolar Disorder

Bipolar disorder, as its name suggests, manifests with mood swings. The symptoms exhibited by those with bipolar disorder depend on whether the person is undergoing a manic mood or a depressive mood.  For example, a person exhibiting a manic episode might be overly happy and outgoing—the “life of the party”—or be highly irritable or jumpy. They may talk very rapidly, be easily distracted and restless, have difficulty sleeping, behave impulsively and do high-risk behaviors (unsafe sex, spending sprees, impulsive investments). When that person is in a depressive episode, however, they may undergo long periods of worry or feeling “empty,” lose interest in hobbies, sex, or other activities, feel very tired and “slow,” have difficulty concentrating or remembering, see changes in eating or sleeping, and entertain suicidal thoughts or even attempt suicide (NIMH, 2008).

In severe cases, those with bipolar disorder can become violent, either toward others or themselves; approximately 25% of people with bipolar disorder attempt suicide (Barrett, 2008).

The cause of bipolar disorder is unknown, but it is a biological illness. Several areas of the brain, including the thalamus, hypothalamus, amygdala, caudate, prefrontal cortex, and cerebellum may be involved, along with neurotransmitters serotonin, nerepinephrine, dopamine, and acetylcholine (Barrett, 2008).

There are several different types of bipolar disorder, some more serious than others. WebMD describes these forms of bipolar disorder as falling into categories of Bipolar I, Bipolar II, Rapid Cycling, Mixed Bipolar, and Cyclothymia. Bipolar I is the most severe form of the disease and involves at least one full-out manic episode in which the unusual, “high” mood is not warranted by external events, and which results in a disruption with the person’s life. People with Bipolar I may require hospital care when in the grip of their manic episodes.  Bipolar II while much the same as Bipolar I, has less extreme manic episodes. A person with Bipolar II may never have experienced a full-out manic episode, but does fall into depressive episodes. In between these less-than-manic highs and the lows of depression, this person may be basically normal. Rapid Cycling bipolar disorder is defined as one in which there are four or more episodes of either mania or depression within one year.  Possibly between 10% and 20% of those with bipolar disorder exhibit Rapid Cycling. Mixed Bipolar is a form in which the person exhibits the characteristics of both mania and depression more or less concurrently; this is an indicator of Bipolar I level disease. While estimates vary substantially, WebMD reports that between 20% and 70% of those with bipolar disorder experience the Mixed Bipolar symptoms. Finally, Cyclothymia is a mild form of Bipolar disorder; instead of being categorized as a mental illness, it is instead considered a “mood disorder” in which the mood swings from mild depression to mild “highs” that never achieve the level of a mania. This version of bipolar disorder appears to affect between 1/2 and 1% of the population in the U.S.  (WebMD, 2005-2011)

A manic episode is diagnosed with rapid, slowed, or incoherent speech, changes in weight, irritability, grandiosity, distractibility, and overt psychosis. Depressive episodes are characterized by abnormal sleep patterns (too much or too little), significant weight changes, indecisiveness and lack of concentration, loss of energy or fatigue, psychomotor agitation or retardation, feelings of worthlessness and guilt, and thoughts of suicide or death (Barrett, 2008).

While no one knows the cause of bipolar disorders, some triggers for either depressive or manic episodes can be identified. For those vulnerable to bipolar disorder, episodes for either mania or depression can be sparked by major life stresses (moving, divorce, childbirth, etc.), certain medications (antidepressants, steroids), extended loss of sleep, and recreational drug use (Merrill & Zieve, 21 March 2010). Since bipolar disorder tends to run in families, there is likely a genetic vulnerability involved.

An additional complication is that bipolar disorder often is accompanied by other illnesses, in particular substance abuse (drugs or alcohol), anxiety disorders (post-traumatic stress disorder), obsessive-compulsive disorder, and attention deficit hyperactivity disorder.  There are also physical complications that often accompany bipolar disorder, such as increased risk for thyroid problems, migraines, heart disease, diabetes, and obesity (NIMH, 2008).